Sen. Susan Collins, R-Maine, is one of the GOP moderates who have been pushing an alternate version of healthcare reform than the working group of senators convened by Republican leadership. (Shirley Li/Medill/CC BY 2.0)

As the Senate charts a path forward on healthcare legislation, it faces the same hurdles that nearly sank the House’s effort—namely, a divide between the party’s conservative and moderate factions.

On the conservative side, some GOP senators are pushing for even deeper cuts to Medicaid than were outlined in the House’s version of the bill to repeal and replace the Affordable Care Act, according to the Wall Street Journal. For one, they want to change federal funding of Medicaid by tying it to a different inflation measure, meaning less generous payments to states in the long term than under the House bill.

In addition, lawmakers including Sen. Mike Lee, R-Utah, want to immediately start paring back federal funding for Medicaid expansion, rather than leaving the ACA’s enhanced federal funding untouched until 2020 for the states that have already expanded Medicaid.

When it comes to the individual market, one idea that conservatives have floated is to remove the ACA’s essential health benefits requirement and allow states to opt back in, CNN reported. Under the House bill, states currently have the option of opting out of that provision.

Another idea, offered by Sen. Lamar Alexander, R-Tenn., is to allow states to repeal ACA regulations if they automatically enroll customers in catastrophic coverage. However, some conservatives decried that concept as “corporatist single payer,” according to the article.

GOP centrists, meanwhile, led by Sen. Susan Collins, R-Maine, and Sen. Bill Cassidy, R-La., are also seeking to throw around their weight. Though they aren’t part of the Senate’s official working group, Cassidy and Collins have met with Senate leaders to discuss their own, previously introduced version of an ACA repeal bill, The Hill reported.

Both have also reached out to Democrats, Politico noted, and there is an appetite among some senators, like South Carolina Republican Lindsey Graham, for bipartisan work on healthcare. Indeed, if Republicans fail to pass a healthcare bill in a party-line vote—which some see as likely—they may need to reach across the aisle and forge a compromise.

Yet as it stands now, neither party stands to gain much politically from working together, and some leaders in the Senate have even discouraged members from doing so, the article added.